Loneliness among US adults in the 2024 National Health Interview Survey

Importance: Loneliness is associated with premature mortality and poor mental health and was declared an epidemic by the US Surgeon General in 2023, but national surveillance has relied on state-based or experimental online surveys. In 2024, the National Health Interview Survey measured loneliness directly for the first time. Objective: To estimate the national prevalence of loneliness among US adults, identify the sociodemographic groups with the highest burden, and quantify associations with mental health, health status, and health care use. Design: Cross-sectional analysis of the 2024 National Health Interview Survey, a nationally representative household survey conducted continuously from January to December 2024. Setting: US households; face-to-face and telephone interviews. Participants: 32 629 sampled civilian noninstitutionalized adults aged 18 years or older (response rate, 47.9%); 31 470 (96.4%) had valid loneliness data. Exposures: Frequent loneliness, defined as feeling lonely always or usually on a 5-category item (always, usually, sometimes, rarely, never). Main Outcomes and Measures: Survey-weighted prevalence of loneliness overall and by sociodemographic characteristics, and associations of frequent loneliness with serious psychological distress (Kessler 6 scale score 13 or higher), frequent feelings of depression and anxiety, life dissatisfaction, fair or poor self-rated health, receipt of counseling or therapy, cost-related unmet mental health care need, and emergency department use. Results: In 2024, 4.9% (95% CI, 4.6%-5.2%) of US adults, an estimated 12.2 million people, felt lonely always or usually, and 23.7% (95% CI, 23.1%-24.3%), an estimated 59.3 million, felt lonely at least sometimes. Prevalence of frequent loneliness was highest among adults with family income below the federal poverty level (10.3%), adults with disability (13.6%), adults living alone (9.0%), and American Indian or Alaska Native adults (12.2%). Adults aged 65 years or older had the lowest prevalence of any age group (4.0%) and adults aged 18 to 29 years the highest (6.3%). After adjustment for sociodemographic characteristics, frequent loneliness was associated with serious psychological distress (adjusted odds ratio, 14.5; 95% CI, 12.1-17.3), life dissatisfaction (9.0; 95% CI, 7.6-10.8), cost-related unmet mental health care need (4.3; 95% CI, 3.5-5.2), and emergency department use (1.8; 95% CI, 1.5-2.0). Conclusions and Relevance: Loneliness among US adults was patterned by poverty, disability, and household structure rather than older age. These estimates from the nation's principal household health survey provide a benchmark for monitoring loneliness and suggest that strategies for social connection should address material hardship and access to mental health care.